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tics [2026/08/06 20:51] – [References] Scott Larsontics [2026/08/06 20:54] (current) – Scott Larson
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 ====== Tics ====== ====== Tics ======
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   * Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization that is experienced as involuntary but can often be temporarily suppressed.    * Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization that is experienced as involuntary but can often be temporarily suppressed. 
   * Typical onset between ages **4–6 years** and are preceded by a premonitory urge   * Typical onset between ages **4–6 years** and are preceded by a premonitory urge
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 ===Pharmacotherapy (when behavioral therapy is insufficient or unavailable)=== ===Pharmacotherapy (when behavioral therapy is insufficient or unavailable)===
  
-- **First-line: Alpha-2 agonists** — **guanfacine** and **clonidine** have moderate evidence and a favorable side-effect profile (sedation, hypotension); preferred as initial medication in children. Particularly useful when comorbid **ADHD** is present. +  * **First-line: Alpha-2 agonists** — **guanfacine** and **clonidine** have moderate evidence and a favorable side-effect profile (sedation, hypotension); preferred as initial medication in children. Particularly useful when comorbid **ADHD** is present. 
-- **Second-line: Atypical antipsychotics** — **aripiprazole**, **risperidone**, and tiapride have evidence for tic reduction but carry risks of metabolic syndrome and tardive dyskinesia. +  * **Second-line: Atypical antipsychotics** — **aripiprazole**, **risperidone**, and tiapride have evidence for tic reduction but carry risks of metabolic syndrome and tardive dyskinesia. 
-- **Third-line: Typical antipsychotics** — haloperidol and pimozide are effective but reserved for refractory cases due to significant adverse effects (extrapyramidal symptoms, QT prolongation).+  * **Third-line: Typical antipsychotics** — haloperidol and pimozide are effective but reserved for refractory cases due to significant adverse effects (extrapyramidal symptoms, QT prolongation).
  
 **Comorbidities** are common and should be assessed: **ADHD** (alpha-2 agonists can treat both), **OCD** (SSRIs or CBT with exposure/response prevention), anxiety, and learning difficulties. **Comorbidities** are common and should be assessed: **ADHD** (alpha-2 agonists can treat both), **OCD** (SSRIs or CBT with exposure/response prevention), anxiety, and learning difficulties.